Effects Of The Hospital Referral System Nursing Essay.

Health referral systems form a major component of the healthcare structure globally. Referral has been defined as a process in which the treating physician at a lower level of the health service, who has inadequate skills by virtue of his qualification and/or fewer facilities to manage a clinical condition, seeks the assistance of a better equipped and/or specially trained person, with better resources at a higher level, to guide him in managing or to take over the management of a particular episode of a clinical condition in a beneficiary (Al Mazrou et al, 1990).Effects Of The Hospital Referral System Nursing Essay.

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The healthcare structure in Kenya employs a referral system where patients are transferred from lower level facilities to higher level centres depending on their need for specialized care. The public national referral hospitals namely; Kenyatta National Teaching and Referral Hospital (KNH) in Nairobi city and Moi Teaching and Referral Hospital (MTRH) in Eldoret town are at the apex of the healthcare system providing sophisticated diagnostic, therapeutic and rehabilitative services. These two facilities serve a complex network of over 4700 health facilities countrywide categorized into various levels depending on the degree of speciality of services they provide. The private sector contributes about 49% of these facilities with several privately owned hospitals complementing the national referral hospitals by providing highly specialized services.Effects Of The Hospital Referral System Nursing Essay.

The Ministry of Medical Services has committed itself to “re-invigorate” the hospital referral system with an aim of achieving capacity to offer quality cost efficient referral services by revising the current referral procedures, upgrading basic skills of service providers and enhancing communication and transport facilities. (Ministry of Medical Services Strategic Plan 2008-2012).Effects Of The Hospital Referral System Nursing Essay. This will be in keeping in line with Kenya Vision 2030, Kenya’s development blueprint covering the period 2008 to 2030 which aims at providing an efficient and high quality health care system with the best standards. Having this commitment in mind, it is necessary to examine the effects of the current referrals on health service provision to bring out the positives and limitations of the referral system. This will culminate into focused interventions to make the system more efficient.Effects Of The Hospital Referral System Nursing Essay.

Just as any system comprises of a set of interacting or interdependent components forming an integrated whole (Buckland 2000), the referral system is made up of several interrelated processes geared towards improving the health of the patient. One of the key components of the referral process is communication. Effectiveness of a hospital referral system depends largely on the ability to make the transfer of patient medical information from one healthcare worker to another in a timely and comprehensive manner. Poorly handled paperwork, incomplete notes and inadequate pre-referral investigations can result in missed and delayed diagnosis eventually increasing the burden of morbidity and mortality.Effects Of The Hospital Referral System Nursing Essay.

This study will examine the mode of communication of laboratory investigations carried out by the primary clinician to the referral facility. It aims to highlight any effects of this referral system on the quality of information transferred and the resultant impact on the process of investigation. It is hoped that any gaps identified will form a useful beginning point towards making investigations of referred patients more timely, cost-efficient and appropriate.Effects Of The Hospital Referral System Nursing Essay.

The study will be carried out in Kenyatta National Teaching and Referral Hospital (KNH). Being the largest and busiest national referral centre in Kenya it is hoped that the information gathered will not only be used to enhance the referral process to KNH but will used to improve the referral system countrywide.Effects Of The Hospital Referral System Nursing Essay.

1.2 Problem Statement:

The process of referral largely involves the transfer of patient information from one clinician to another. This information is expected to contain the general clinical history of the patient, the type and findings of pre-referral investigations and the reasons for referral. With the initial baseline investigations having been done, the receiving clinician will focus on specialist investigations and management of the patient.Effects Of The Hospital Referral System Nursing Essay.

The process of communicating pre-referral investigations is prone to mishandled or lost paperwork. The information is also likely to be inadequate due to time pressure required to write complete notes. In such cases the receiving clinician will be forced to repeat these investigations increasing the cost burden to the hospital and the patient. This may also lead to increased waiting times and delayed diagnosis resulting in disease complications and increased morbidity and mortality.Effects Of The Hospital Referral System Nursing Essay.

1.3 Justification:

The results of this study can be used to generate secondary data as to the magnitude, scope and socio-demographic characteristics of patients referred to KNH which can be used as baseline data for strategic planning, putting up of other referral facilities and targeting of specific disease zones.Effects Of The Hospital Referral System Nursing Essay.

The results of this study can give clinicians and hospital administrators in KNH an insight into the current referral process and its effects on investigating patients with an aim of addressing gaps identified.Effects Of The Hospital Referral System Nursing Essay.

This study will also provide the policy makers at the Ministry of Health with information on the referral constraints faced by other peripheral health facilities which refer patients to KNH with an aim of addressing them.Effects Of The Hospital Referral System Nursing Essay.

1.4 Research Questions:

The need to improve the current referral process means understanding its effects on delivery of healthcare.

This research aims to bring this understanding by answering the following questions;Effects Of The Hospital Referral System Nursing Essay.

What are the socio-demographic characteristics of patients referred to KNH?

What are the effects of the referral process on investigating patients referred to KNH?

1.5 Objectives of the study:

To determine the socio-demographic characteristics of patients referred to KNH in the year 2013.

To determine the number of repeated investigations attributed to improper or mishandled documentation of pre-referral investigations among patients referred to KNH in the year 2013.Effects Of The Hospital Referral System Nursing Essay.

To establish the extra cost attributable to repeated investigations due to improper or mishandled documentation of pre-referral investigations among patients referred to KNH in the year 2013.Effects Of The Hospital Referral System Nursing Essay.

CHAPTER TWO:

LITERATURE REVIEW:

2.1 Introduction

The whole process of generating a clinical referral for a patient and the resulting transfer from the primary physician to the specialist and back again, are key components in the struggle to deliver less costly and more effective clinical care. As larger and more complex integrated healthcare delivery networks continue to emerge, the problems of finding an appropriate specialist and communicating patient information from one provider to another has become increasingly important (Clancy et al, 1996). The competition between healthcare delivery systems keeps increasing resulting in the need to provide customer service in terms of prompt, polite and informative communication to referring physicians (Montalto, 1998).Effects Of The Hospital Referral System Nursing Essay.

2.2 Socio-demographic Factors

Socio-demographic characteristics have been found to influence the process and extent of referral of patients from primary care to specialized care (McBride et al, 2010). While carrying out research in variation in referral in the United Kingdom, McBride et al (2010), were able to establish the following; that the likelihood of referral to secondary care was associated with patient’s age, sex and social deprivation; older patients were less likely to be referred for all symptoms and that socioeconomic inequalities in referral were more likely to occur in the absence of both explicit guidance and potentially life threatening conditions.Effects Of The Hospital Referral System Nursing Essay.

While carrying out a customer satisfaction survey at the Accident and Emergency Department of Kenyatta National Hospital where referred patients are first received, Chika et al (2010), found out that there was almost the same number of females as there was of males visiting the Accident and Emergency Department. 28.7% of the patients had their highest level of education as Primary School while 39.9% had their highest level of education as Secondary School. 7.9% had no formal education while 3.2% had their highest level of education as University. The study also revealed that 70.6% of the patients received at this department had an average monthly income of less than KShs 10,000.Effects Of The Hospital Referral System Nursing Essay.